Background: Visceral leishmaniasis, also known as kala-azar, is a vector borne disease caused by the
protozoan parasite, L. donovani. It is endemic in areas bordering the Mediterranean Sea. Untreated visceral
leishmaniasis has fatal course. Therefore, early diagnosis and specific therapy with pentavalent antimony
drugs are mandatory.
The aim of this study was to analyze patients hospitalized for investigation of hepatosplenomegaly that
turned out to be visceral leishmaniasis.
Material and methods: This retrospective study was carried out at University Children's Hospital Skopje,
Macedonia - Department of Gastroenterohepatology in 2011-2012. Data were analyzed for age, gender,
place of residence, clinical symptoms, investigations, treatment and outcome.
Results: During 2 years period 4 patients were included. Mean age was 17,5 months (range 6 months to
2,5 years), 75% were female. The main clinical signs and symptoms of the patients were
hepatosplenomegaly (100%), abdominal distension (75%) and fever (50 %). Anemia was the most frequent
hematological abnormality found in all patients, mean hemoglobin value 86.2 ± 17.3 g/l. Trombocytopenia
was present in half of the patients. Elevated liver enzymes were present in 75%, AST 181,0 ± 190,1U/l , ALT
106,2 ± 106,0 U/l and hypergamaglobulinemia in 50% of the patients. The diagnosis was made by detecting
leishmainias in bone marrow aspirate associated with positive serology. All patients were treated with
meglumine antimonate (glucantime), achieving rapid clinical and laboratory response.
Conclusion: Visceral leishmaniasis is an existing infection among children in Macedonia. It should be
considered in differential diagnosis of hepatosplenomegaly with or without fever.

A. Kostovski1, N. Zdraveska2, S. Koceva3
1Pediatric Gastroenterohepatology, University Children`s Hospital Skopje, 2University Children's Hospital
Skopje, 3Pediatric Hematology, University Children`s Hospital Skopje, Skopje, FYROM - The Former
Yugoslav Republic of Macedonia


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